Nursing and Health 2(3): 65-71, 2014 http://www.hrpub.org DOI: 10.13189/nh.2014.020302 Understanding Philosophy in a Nurse’s World: What, Where and Why? Anne Bruce *, Lori Rietze, Angela Lim University of Victoria, Canada *Corresponding Author: [email protected] Copyright © 2014 Horizon Research Publishing All rights reserved. Abstract Concerns raised about the relevance of introductory framework for understanding philosophy as a) philosophy to the work of nurses have prompted us to content, b) method, and c) a way of life to highlight the examine the importance of philosophy in professional interdependence of philosophy and practice in our discipline. nursing. We introduce diverse understandings of what We anticipate that a broader understanding of philosophy philosophy is, provide an overview of analytical and and philosophical thinking in a nurse’s world will be of continental philosophies, and describe how philosophy is interest to clinically-based nurses as well as nurse educators. central to the work of nurses, educators and researchers. The discussion is situated in what some scholars view as a growing milieu of anti-intellectualism, instrumentalism, and 1. Who has Time to Philosophize? The neoliberalism. A three-pronged framework of philosophy is Socio-Political Context presented to help demonstrate the pervasiveness and magnitude of philosophy in nursing practice today. Philosophical thinking in nursing is provoked by problems Philosophy helps nurses to think more critically and reflect that nurses confront every day in clinical practice [3]. Such on how their own values influence their practice and way of problems are complex, multidimensional, and often not fully being. A better understanding of the importance of resolvable. Even so, Forss, Ceci and Drummod [3] caution philosophy in the nurses’ world is not only relevant but vital that despite the nature of philosophical questions that do not to our discipline and professional practice. A broader lead to singular answers, “still we must try" (p. iii). Nurses understanding of the interdependence of practical and do try, and continue to engage in philosophical thinking philosophical matters in professional nursing is needed. about ethical, existential, and complex practice questions amidst barriers within socio-political and educational Philosophy, Nursing, Analytical, Keywords contexts. Continental, Anti-Intellectualism As a group with one faculty member and four doctoral students, we agree with Forss, Ceci and Drummod who state that "doing nursing, being a nurse, contains as much a “Philosophical inquiry does not lead to one correct philosophical dimension as it does a practical one" [3]. We answer but enables the articulation of various views of believe resistance to philosophy amongst nurses and nursing knowledge and therefore of nursing practice” [1] students is not only reflective of the practice nature of our Philosophy is often seen as a mystifying topic that is far discipline, or the way philosophical thinking is taught (if at removed from nursing practice. With abstract arguments and all) in nursing programs. Instead, we locate our discussion highly technical language, philosophy is frequently seen as within current socio-political considerations. We argue that too distant from the everyday practice and realities of nurses discourses of anti-intellectualism, instrumentalism, and to be practical or meaningful [2]. Even doctoral students in neoliberalism reflect broader philosophical shifts in nursing are leery of philosophy and its relevance as they education and practice domains. Nursing education, as the question, “How can I use and relate to this [emphases foundation to a practice profession, is especially vulnerable added]?” [2]. In this paper we address two broad questions: to these philosophical discourses [4]. The major barriers of what is philosophy and how is it important in nursing anti-intellectualism, instrumentalism and a neoliberal agenda practice? To address these questions, we start by exploring inform the context we explore in order to better understand the trends of anti-intellectualism, instrumentalism, and resistance to philosophy in nursing. neoliberalism that inform the socio-political context of resistance to philosophy in nursing. Next, we introduce 1.1. Anti-Intellectualism philosophy and the common categorizations of analytical and continental philosophy. Lastly, we propose an Anti-intellectualism is described by Hofstadter in his 66 Understanding Philosophy in a Nurse’s World: What, Where and Why? compelling book entitled Anti-Intellectualism in American autonomy and accountability” [9]. Never-the-less, neoliberal Life, as “a resentment and suspicion of the life of the mind beliefs are shaping health care organizations and nursing and those who are considered to represent it; and a practice [10] and according to Sulavikova [9] these political disposition to constantly minimize the value of that life” [4]. and economic values are increasingly determining In nursing, Miers [5] argues that anti-intellectualism has educational agendas across disciplines. been a longstanding phenomenon fueled by a rift between Although a full discussion of neoliberalism would take us clinicians and academics. In this context, there is an too far afield, the basic principles of this politico-economic assumption that abstract thinking is perceived to be more theory will be highlighted since they are foundational to valued by academic nurses over pragmatic, skill-based social policy decisions [11] and directly inform how nurses knowledge of clinical practice. Miers [5] reports findings think about knowledge and nursing practice. Two examples from a small study in the U.K. and links her findings to the illustrate the impact of neoliberalism and its unquestioned historic barriers to women in higher education along with role in shaping nursing knowledge and practice. several factors that are supported by other scholars [6,7]. Tomm-bonde [11] argues that nursing knowledge has been These findings support a view of nursing as a practice shaped within Western-based neoliberalism that emphasizes discipline that does not require graduate-level skills. individualism and economic growth. In a recent study called, Similarly, there is a belief that nursing knowledge is based The Naïve Nurse: Revisiting Vulnerability for Nursing, on experiential learning through clinical practice with less of Tomm-bonde demonstrates how the concept of vulnerability a requirement for nursing research, and a perception of has been explicitly shaped by taken-for-granted assumptions hierarchy from academic nurses who value abstract thinking of the person as separate from their social, political, and skills over practical nursing skills. While the U.K context of gendered context. The author ties this ontology of person Miers’ [5] study may present unique considerations for the within a neoliberal “paradigm of individualism”. That is, the development of nursing in that country, we believe primacy of the individual as independent (of the collective) socio-political and global economic forces are shaping and self-reliant. Often unquestioned, the assumption of nursing education and health care practices irrespective of individualism effectively overlooks historical, political, and geography or discipline. power structures that secure individual rights of some groups more than others. This oversight obscures how some marginalized populations, rather than individuals alone, 2. Neoliberalism and Instrumentalism must also be considered vulnerable and requiring care. The complexity of healthcare systems necessitates broader Neoliberalism is a term that originated in Europe in the understandings of nursing knowledge within an expanded 1930’s that describes a range of market-driven values and socio-political context. beliefs that have been shaping policies and practices since A second example from a recent study of palliative care the 1970s. Bockman [8] suggests that after the Great district nursing [12] identified discourses of ‘busyness’, tied Depression of 1929 a new form of ‘liberalism’ was to efficiency and economic growth, as a significant narrative. envisioned that would preserve laissez-faire market The authors conducted a qualitative inquiry and concluded economies while developing a new role for government, that nursing discourses operate at a moral level and a albeit a minimal role, to support economic growth and social discourse of busyness that is tied to efficiency (economic equity. The new (neo) liberalism of the 1930s has changed value) negatively shapes, by precluding, a moral form of considerably since its inception. There is now an increased nursing care. The language of busyness influences how emphasis on creating conditions for profitability while nurses “think about quality of care” away from the moral eradicating government’s role in social services, education, imperative of care[12]. and welfare; these shifts were never intended when the In summary, in a socio-political context where values of theory was first developed [8]. Nevertheless, Sulavikova [9] efficiency productivity and the commodification of defines neoliberalism as a belief system built on principles of knowledge and care are on the rise, it is not surprising that individualism and free-markets “accompanied by the values the pursuit of philosophical thinking in nursing is threatened. of free competition, decentralization, freedom, personal After all, who has time anymore to think—or question autonomy and accountability”.